Provider Demographics
NPI:1962683524
Name:CRAIG MAXWELL, D.D.S., P.C.
Entity Type:Organization
Organization Name:CRAIG MAXWELL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:B.
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-276-4417
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:201 WEST SMITH DRIVE
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-0609
Mailing Address - Country:US
Mailing Address - Phone:417-276-4417
Mailing Address - Fax:417-276-6279
Practice Address - Street 1:201 WEST SMITH DRIVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-0609
Practice Address - Country:US
Practice Address - Phone:417-276-4417
Practice Address - Fax:417-276-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060001871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty